A Girdlestone procedure is the surgical removal of the femoral head, the ball-shaped top of the thighbone that fits into the hip socket. The operation eliminates the joint itself, leaving behind what surgeons call a “pseudoarthrosis,” a false joint held together by scar tissue and surrounding muscles rather than bone-on-bone contact. It is named after Gathorne Robert Girdlestone, who described it in 1945 as a way to treat severe hip infections that could not be controlled any other way.1Journal of Bone Joint Infection. The Girdlestone situation: a historical essay The procedure remains in use today, though its role has narrowed considerably. It is generally a last-resort surgery, and understanding what it involves, who it is for, and what life looks like afterward gives patients and families a realistic picture of what comes next.
Why Surgeons Still Perform It
The Girdlestone procedure is almost never the first choice. It exists for situations where other hip surgeries have failed, are too risky, or simply are not possible. The most common scenario in high-income countries involves a hip replacement that has become deeply infected. When antibiotics and less radical surgeries cannot clear the infection, removing the prosthesis and the surrounding infected tissue is sometimes the only way to save the patient’s life or limb. The procedure remains a treatment of choice for controlling hip infection, even though functional outcomes are poor.2PubMed Central. A 5-year follow-up of Girdlestone resection arthroplasty in hip infection continued by Total hip replacement: A case report
Beyond infected hip replacements, there are other circumstances that lead to a Girdlestone. In some parts of the world, patients with neglected femoral neck fractures, failed internal fixation hardware, or painful bone death in the femoral head who cannot access or afford a hip replacement may undergo the procedure as a primary treatment.3PubMed Central. Is Head and Neck Resection of the Femur (Girdlestone’s Procedure) Still Relevant? Indications and Results About 24 Cases In wealthier health systems, its indications tend to be more specific. Absolute reasons include patients who are already non-ambulatory due to other conditions and patients for whom reimplantation of a new hip is impossible because of unacceptable surgical risk, technical obstacles, or the patient’s own refusal. Relative reasons include dementia, significant immune system compromise, and intravenous drug use, each of which raises concerns about whether a replacement hip could survive long-term without reinfection or dislocation.4PubMed. Girdlestone procedure: when and why
What Happens During the Surgery
The operation itself involves removing the ball of the femoral head and a portion of the femoral neck. If a prosthetic hip is already in place, the surgeon removes all components of the artificial joint along with any cement used to fix them. All infected or dead tissue is cleaned out aggressively. In cases of infection, the surgeon typically takes tissue samples for culture and may pack the wound with antibiotic-loaded materials. After the bone and soft tissue are removed, nothing replaces them. The space where the joint used to be gradually fills with scar tissue over the following weeks and months, creating a fibrous connection between the remaining femur and the pelvis. This scar tissue provides some stability but far less than a normal hip joint or a hip replacement.
Surgery time varies depending on the complexity of the case. Removing a cemented prosthesis from infected bone can be a lengthy process, and significant blood loss is not uncommon. Patients are placed in traction or a specific position postoperatively to maintain limb alignment while the scar tissue forms.
How Well It Clears Infection
If the primary goal is eradicating a deep hip infection, the Girdlestone procedure does accomplish that in most cases, though not all. One study of hip joint infections found an infection control rate of about 96%, though functional results were poor.5PubMed Central. Surgical therapy of hip-joint empyema. Is the Girdlestone arthroplasty still up to date? A larger study looking specifically at refractory prosthesis infections reported a lower rate, with infection cleared in about 71% of cases.6PubMed. Results of the Girdlestone Procedure for the Treatment of Refractory Hip Prosthesis Infections The gap between those numbers likely reflects how stubborn the infections were. In the latter study, the patients had already failed other attempts at treatment, so their infections were harder to eradicate. The takeaway is that while the procedure clears infection in the majority, roughly a quarter to a third of the most resistant cases may persist or recur, sometimes requiring additional surgery or long-term antibiotic suppression.
Mobility and Independence After Surgery
This is where honesty matters most. The Girdlestone procedure saves limbs and lives, but it comes at a steep functional cost. Without a femoral head, the hip cannot work the way it was designed to. The leg on the operated side shortens, the muscles around the hip lose their mechanical leverage, and the joint’s range of motion decreases dramatically. Most patients experience a severe loss of independence afterward.
One study following patients after Girdlestone for hip fracture found that roughly two-thirds of those who survived to one year were immobile, and the rest all required a walking frame.7PubMed. What is the outcome after a Girdlestone resection arthroplasty following a hip fracture? Another study found that about 78% of patients with a unilateral Girdlestone had poor functional scores on a standard hip assessment.8Acta Ortopédica Brasileira. Evaluation of the function and quality of life of patients submitted to girdlestone’s resection arthroplasty Studies consistently describe significant leg length discrepancy and altered hip biomechanics as major contributors to these outcomes.9PubMed Central. Femoral nerve palsy following Girdlestone resection arthroplasty: An observational cadaveric study
Average leg length discrepancy has been reported around 5.5 centimeters, which is roughly two inches.10PubMed Central. Modified Girdlestone arthroplasty and hip arthrodesis using the Ilizarov external fixator as a salvage method in the management of severely infected total hip replacement That kind of discrepancy throws off your entire gait and makes walking without a significant shoe lift or build-up extremely difficult. Many patients rely on walking frames or wheelchairs permanently. For those who were already unable to walk before surgery due to infection or other conditions, the functional loss may be less noticeable than for a patient who was still mobile beforehand.
Pain and Quality of Life
Pain after a Girdlestone is a mixed picture. Some patients do get meaningful pain relief, particularly those whose preoperative pain was driven by active infection or a failing prosthesis. The same study that found poor functional outcomes also noted that pain, emotional well-being, and mental health scored reasonably well on quality-of-life scales, even though functional capacity and physical ability scored poorly.8Acta Ortopédica Brasileira. Evaluation of the function and quality of life of patients submitted to girdlestone’s resection arthroplasty But pain does not disappear for everyone. In a Spanish study, eight patients maintained pain levels above moderate on a standard pain scale, and the degree of leg length discrepancy was closely tied to worse self-perceived health.11PubMed. Quality of life after Girdlestone resection arthroplasty
A broader quality-of-life assessment paints a sobering overall picture. In one study comparing Girdlestone patients to the general population, quality-of-life scores were significantly lower across every measured domain. Over 95% of patients reported problems with mobility, about 78% needed help with self-care, about 91% had difficulty with daily activities, roughly 85% experienced ongoing pain or discomfort, and more than half reported anxiety or depression. When patients rated their own overall health on a 0-to-100 scale, the average score was about 52, compared to 82 in the general population. To put that in perspective, these scores were worse than those reported by people who had survived heart attacks or even lower limb amputations.12PubMed Central. Quality of life and health status after Girdlestone resection arthroplasty in patients with an infected total hip prosthesis
Complications and Mortality
The Girdlestone procedure carries serious risks, partly because the patients who need it tend to be medically complex. Many are older, have multiple health conditions, or have already endured several surgeries. In one analysis looking at outcomes within 90 days of surgery, major complications occurred in about a third of patients, minor complications in roughly one in ten, and reoperation was needed in about 8% of cases. The 90-day mortality rate in that analysis was about 11%.13Global Journal of Orthopedics Research. Girdlestone Resection Arthroplasty: Indications, Outcomes, and Complications Those complication and mortality numbers are considerably higher than what is seen after routine revision hip replacement, which reflects both the severity of the underlying problem and the frailty of the patient population. Higher body mass index and a history of chronic obstructive pulmonary disease were the factors most strongly linked to complications, while age alone was not.
One complication that receives less attention is femoral nerve injury. The removal of bone and tissue can change the anatomy around the nerve, and cadaveric research has explored how the nerve’s position shifts after resection.9PubMed Central. Femoral nerve palsy following Girdlestone resection arthroplasty: An observational cadaveric study Femoral nerve palsy can affect thigh sensation and the ability to extend the knee, further compounding mobility problems.
The Mental Health Side
The physical consequences of a Girdlestone do not exist in isolation. A multicenter study that specifically assessed both physical and mental health after the procedure found that physical health scores fell about 10 points below the U.S. population average, while mental health scores were nearly 4 points below average. The median ambulation score was essentially zero, meaning most patients reported almost no independent walking ability. Frustration levels were moderate, and patients reported a substantial social burden from the procedure.14PubMed Central. A Multicenter Prospective Investigation on Patient Physical and Mental Health After Girdlestone Resection Arthroplasty
That mental health gap, while smaller than the physical health gap, matters. Losing the ability to walk, becoming dependent on others for basic self-care, and living with a visibly shortened limb all take a psychological toll. The anxiety and depression rates reported in quality-of-life studies bear this out. If you or a family member is facing this procedure, planning for mental health support is just as important as planning for physical rehabilitation.
What Recovery and Rehabilitation Look Like
Recovery after a Girdlestone is slow and guided carefully. In the early postoperative period, the operated leg is typically kept in traction or a specific position to allow scar tissue to form in a way that provides some stability. Initial exercises focus on preventing blood clots and maintaining strength in the rest of the body: ankle pumps, static muscle contractions on the affected side, and stretching on the unaffected side. Once traction is discontinued and the surgical wound has healed, rehabilitation progresses to basic mobility tasks like rolling in bed and sitting up, then gradually standing and taking steps with a walker.15PubMed Central. A Holistic Approach for Physiotherapy Rehabilitation of Girdlestone Arthroplasty With Infection and Concomitant Contralateral Spastic Hemiplegic Cerebral Palsy: A Case Report
The timeline varies enormously depending on the patient’s overall health, the reason for the procedure, and whether a later reconstruction is planned. Some patients are in rehabilitation for months. The goal is not to return to normal hip function, because that is not possible without a joint. The goal is to maximize whatever mobility and independence the individual patient can achieve, which may mean walking short distances with a frame or simply being able to transfer safely from bed to chair. A shoe lift or built-up shoe is almost always necessary to compensate for the leg length difference, and many patients use a wheelchair for longer distances permanently.
Can You Get a Hip Replacement After a Girdlestone
Yes, and this is an important part of the conversation. For many patients, the Girdlestone is intended as a temporary stage in a two-part process: first, remove the infected hardware and clear the infection, then, once the infection is confirmed gone, implant a new hip replacement. This second stage is called a conversion or reimplantation, and it is technically demanding. The surgeon has to work with bone that has been weakened, reshaped, and sometimes significantly eroded. Despite these challenges, conversion of a Girdlestone to a total hip replacement can yield good functional results and restore a meaningful degree of independence.16PubMed. Conversion of resection arthroplasty to total hip replacement
A retrospective study comparing patients who had a hip replacement after Girdlestone to patients undergoing standard revision hip replacement found that clinical outcomes were similar between the two groups after the conversion surgery. The converted patients did have greater residual leg length discrepancy afterward, and outcomes were worse in patients older than 70 and in those with larger bone defects in the hip socket.17PubMed. Clinical outcome following conversion of Girdlestone’s resection arthroplasty to total hip replacement: a retrospective matched case-control study The surgery requires careful preoperative planning, including assessment of remaining bone stock, and often involves specialized revision implants and techniques.16PubMed. Conversion of resection arthroplasty to total hip replacement
Not everyone gets to that second stage. Some patients remain too sick, too frail, or cannot clear their infection. Others simply choose not to undergo another major surgery. For these patients, the Girdlestone becomes permanent. The functional results of a permanent Girdlestone may not be satisfactory, and the decision about whether to pursue conversion is one that patients, families, and surgeons weigh carefully based on overall health, bone quality, and personal goals.18PubMed Central. Total Hip Arthroplasty in a Girdlestone Hip following a Failed Hemiarthroplasty
Antibiotic Cement Spacers as a Bridge
When the plan is a two-stage process, surgeons sometimes place an antibiotic-loaded cement spacer in the hip at the time of the Girdlestone. This spacer serves multiple purposes: it delivers high concentrations of antibiotics directly to the infected area, it maintains the spacing between the pelvis and femur to reduce limb shortening, and it helps prevent the soft tissues from contracting and scarring down in ways that make the later hip replacement harder. A study comparing the Girdlestone alone to the Girdlestone with a cement spacer found that the spacer group had better preservation of leg length, less risk of infection recurrence between stages, simpler second-stage surgery with less blood loss, and better functional recovery after the eventual hip replacement.19PubMed Central. Comparison of efficacy and complications between two types of staging arthroplasty in treating chronic septic hip arthritis: A retrospective clinical study
A spacer is not appropriate for everyone. Patients who are not candidates for a second-stage reimplantation, whether due to health, bone quality, or personal choice, typically do not receive one. But when the intent is to eventually reconstruct the hip, the spacer approach has become the preferred strategy at many centers because it keeps the door open for a better long-term result.
Living With a Permanent Girdlestone
For patients whose Girdlestone becomes their final surgery, daily life requires significant adaptation. The two-inch or greater leg length difference means you need a substantial shoe raise on the operated side to stand and walk with any semblance of balance. Even with a shoe raise and a walking aid, the hip lacks the stability and power of a real joint. Sitting is usually manageable, but getting in and out of chairs, beds, and cars takes planning and practice. Many patients use a raised toilet seat and grab bars in the bathroom.
The social dimension is real. Dependence on others for activities like shopping, bathing, and dressing is common, particularly in the early months. Some patients regain enough mobility to manage basic self-care, especially if they are younger, lighter, and motivated with rehabilitation. But the data is consistent: the majority of Girdlestone patients live with serious long-term limitations in mobility and daily function. Knowing this in advance allows patients and families to prepare their living environments, arrange support, and set expectations that match reality rather than hope.